MEDICARE: INTERNAL MEDICINE CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1770002644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE CARE, INC

Provider Business Mailing Address
First Line	:	2510 COMMONS BLVD STE 210
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-3821
Country	:	US
Telephone Number	:	937-558-3061
Fax Number	:

Provider Business Practice Location Address
First Line	:	1989 MIAMISBURG CENTERVILLE RD STE 304
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-3823
Country	:	US
Telephone Number	:	937-429-0607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TROY A TYNER
Credential	:	D.O.
Telephone Number	:	937-558-3061

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/12/2017

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